Healthcare Provider Details

I. General information

NPI: 1891044335
Provider Name (Legal Business Name): ELIZABETH CLAIRE STAHLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY #4300
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

2011 WEST ST
OAKLAND CA
94612-1041
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-9494
  • Fax:
Mailing address:
  • Phone: 617-797-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: